Indiana University Center for Aging Research, Indianapolis, IN 46202, USA.
J Gen Intern Med. 2009 Sep;24(9):1023-8. doi: 10.1007/s11606-009-1065-y. Epub 2009 Jul 25.
Hospitalized patients frequently lack decision-making ability, yet little is known about physicians' approaches to surrogate decision making.
To describe physicians' experiences with surrogate communication and decision making for hospitalized adults.
Cross-sectional written survey.
Two hundred eighty-one physicians who recently cared for adult inpatients in one academic and two community hospitals.
Key features of physicians' most recent surrogate decision-making experience, including the nature of the decision, the physician's reaction, physician-surrogate communication and physician-surrogate agreement about the best course of action.
Nearly three fourths of physicians (73%, n = 206) had made a major decision with a surrogate during the past month. Although nearly all patients (90%) had a surrogate, physicians reported trouble contacting the surrogate in 21% of cases. Conflict was rare (5%), and a majority of physicians agreed with surrogates about the medical facts (77%), prognosis (72%) and best course of action (65%). After adjustment for patient, physician and decision characteristics, agreement about the best course of action was more common among surrogates for older patients [prevalence ratio (PR) = 1.17 for each decade; 95% confidence interval (CI) 1.02-1.31], ICU patients (PR = 1.40; CI 1.14-1.51) and patients who had previously discussed their wishes (PR = 1.60; CI 1.30-1.76), and less common when surrogates were difficult to contact (PR = 0.59; CI 0.29-0.92) or when the physician self-identified as Asian (PR = 0.60; CI 0.30-0.94).
Surrogate decision making is common among hospitalized adults. Physician-surrogate decision making may be enhanced if patients discuss their preferences in advance and if physician contact with surrogate decision makers is facilitated.
住院患者通常缺乏决策能力，但人们对医生在代理决策方面的做法知之甚少。
描述医生在为住院成人进行代理沟通和决策方面的经验。
横断面书面调查。
在一家学术医院和两家社区医院最近照顾成年住院患者的 281 名医生。
医生最近的代理决策经验的关键特征，包括决策的性质、医生的反应、医生与代理人的沟通以及医生与代理人对最佳行动方案的共识。
近四分之三的医生（73%，n=206）在过去一个月内与代理人一起做出了重大决策。尽管几乎所有患者（90%）都有代理人，但医生报告说在 21%的情况下难以联系到代理人。冲突很少见（5%），大多数医生对代理人在医疗事实（77%）、预后（72%）和最佳行动方案（65%）上的看法表示赞同。在调整了患者、医生和决策特征后，对于老年患者（每十年患病率比[PR]为 1.17；95%置信区间[CI]为 1.02-1.31）、ICU 患者（PR=1.40；CI 为 1.14-1.51）和之前讨论过自己意愿的患者（PR=1.60；CI 为 1.30-1.76），代理人更有可能达成一致意见，而对于难以联系代理人的患者（PR=0.59；CI 为 0.29-0.92）或医生自我认同为亚洲人的患者（PR=0.60；CI 为 0.30-0.94），则不太常见。
在住院成人中，代理决策很常见。如果患者事先讨论他们的偏好，并且方便医生与代理人决策制定者联系，那么医生与代理人的决策可能会得到改善。
